Diabetes in Pregnancy: Q&A With Camille E. Powe, MD
Camille E. Powe, MD, a Mass General Brigham endocrinologist, specializes in treating diabetes in pregnancy. Dr. Powe co-directs the Diabetes in Pregnancy Program at Massachusetts General Hospital. She also conducts clinical research on the genetics and physiology of metabolic disease in pregnancy.
In this Q&A, Dr. Powe reflects on how the program’s personalized, integrated, and innovative approach ensures patients receive the most advanced diabetes care available.
Q: What makes the Diabetes in Pregnancy Program unique? How does the collaborative nature of this program create a better patient experience?
Powe: The Mass General Diabetes in Pregnancy Program has three unique features that set us apart.
The first is that it is truly integrative and collaborative. We have endocrine, maternal-fetal medicine, nutrition, and ultrasound specialists all in one place. This makes it easy for all of the different medical providers to connect on individual cases and to work together to come up with the best medical treatment plan for a patient. Our integrated, co-located care model also makes things much more convenient for patients.
The second unique feature is that our program is innovative. We were early adopters of telemedicine before it was popularized. We use both video visits and message-based visits to connect with patients for frequent follow-up. We also take advantage of all advanced diabetes technologies. These include: continuous glucose monitoring, connected glucometers, apps, smart insulin pens, and the latest automated insulin pumps. We make sure our patients get the latest and greatest tools to help care for diabetes.
The third feature is that it’s extremely personalized. We treat each unique patient with an individualized plan that recognizes that all diabetes is not the same.
Q: How does the collaborative nature of this program create a better patient experience?
Powe: Every type of diabetes is different and every person with diabetes is unique. Currently, most treatment for diabetes in pregnancy has a one-size-fits-all approach. Both in our clinical care and research, we are constantly pushing against this.
First, we look at each patient’s case and make sure that they have the right “type” of diabetes diagnosis. It is not uncommon for us to find that people have genetic forms of diabetes that have been misdiagnosed before pregnancy. We always think about this possibility and can arrange genetic testing in these cases.
As far as treatment, we give each patient a personalized nutrition consultation with a dietician who has extensive expertise in both pregnancy and diabetes. They help develop an individualized meal plan that is responsive to the patient’s blood sugars. When a patient needs medications, we tailor the treatment plan to the specific blood sugar patterns that we see in each person.
Q: What kind of diabetes research do you focus on?
Powe: The goal of our research program is to bring all of the advances in diabetes diagnosis and therapeutics from the last decade to pregnant women, who are often left out of clinical studies. Our studies primarily focus on physiology, genetics, and technology.
Q: Do you have any recent findings or upcoming studies about diabetes in pregnancy that you are most excited about?
Powe: One big and exciting study we are doing right now is called GO MOMs. More than 2,000 pregnant individuals from across the country will have joined the study and worn continuous glucose monitors and give blood samples four times over the course of their pregnancy.
Continuous glucose monitors give us 288 glucose readings each day, more than any other way of tracking blood sugar. We’ll look at how these blood sugar profiles relate to traditional gestational diabetes diagnosis and baby birth weights.
The study is expected to revolutionize the way we look for high blood sugar in pregnancy in the first trimester. We are also using the GO MOMs data to see if we can find easier ways to diagnose gestational diabetes, such as using a simple blood test called a hemoglobin A1c.
Another large study we are involved in is called the DECIDE trial. This is a study for people with gestational diabetes who need medication to get their blood sugars to goal. Pregnant people with GDM will be randomly assigned to be treated with either metformin or insulin and followed carefully for 2 years after giving birth. We hope that this study will help us figure out what the best medications are for gestational diabetes.
We are also part of a large study for people with type 1 diabetes called T1D Pregnancy & Me. This study can be fully done online and involves answering questions and giving us access to blood sugar data. We are doing this study because there are still questions about the best ways to achieve the blood sugar goals needed during pregnancy. Although there are many exciting developments in diabetes technology, most of these technologies are not designed to achieve pregnancy blood sugar goals. We hope that this study will help us find ways to improve care and technology for type 1 diabetes in pregnancy.
Finally, we are also working on a study of an automated insulin pump system that was developed at Mass General called the iLet Bionic Pancreas. Our goal is to modify the pump so that we can use it for both type 1 diabetes and type 2 diabetes in pregnancy.
Q: How do you think this research will impact diabetes care?
Powe: We expect our research to change the face of diabetes in pregnancy care so that pregnant patients benefit from all of the latest advances in diabetes research. Many times pregnant and lactating people are excluded from clinical studies. Because of this, they are the last to get the benefits from new discoveries.
We believe this is wrong and we are working hard to change it. Because Mass General Brigham has so much cutting-edge diabetes research and we are passionate about maternal health, in our Diabetes in Pregnancy Program we prioritize ensuring that our patients are already benefitting from every innovation that we have to offer them.
Q: What do you envision for the future of diabetes in pregnancy treatment?
Powe: In the future, I believe that each person who comes into pregnancy with a diabetes diagnosis, or who is diagnosed with gestational diabetes, will have their unique hormonal and genetic profile analyzed. This will help us develop care plan options for treating their diabetes in pregnancy, leveraging all available technologies. In concert with this, each patient will have a group of doctors and other providers that will respectfully put this profile in the context of each person’s daily life habits, values, personal challenges, and structural barriers, to make sure that the care plan is successful.
